1
|
Bell EC, Heng H, Alousis N, King MG, Hahne A, Collins T, See K, Webster T, O'Dowd E, Jackson P, Semciw AI. Patient and Staff Insights on Digital Care Pathways for Patients With Low Back Pain in the Emergency Department: A Qualitative Study. Health Expect 2024; 27:e14182. [PMID: 39152538 PMCID: PMC11329376 DOI: 10.1111/hex.14182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/17/2024] [Accepted: 08/01/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Back pain is a huge global problem. For some people, the pain is so severe that they feel the need to present to an emergency department (ED). Our aim was to explore patient and staff perspectives for the development of a digital care pathway (DCP) for people with back pain who have presented to ED, including acceptability, barriers and facilitators. METHODS We used a descriptive phenomenology approach using semi-structured interviews with patient and staff participants at a tertiary hospital. Interviews were transcribed and data codes were developed using inductive thematic analysis. Themes were discussed between researchers until consensus was achieved. RESULTS A total of 16 interviews were carried out, half of which involved patient participants. We identified three major themes: (i) expectations and experiences of staff and patients with low back pain in ED; (ii) a digital care pathway can empower patients and support clinicians in providing care; and (iii) acceptability, barriers, facilitators and recommendations of engaging with a DCP to track the trajectory of back pain. Each theme was further categorised into subthemes. CONCLUSION Introducing a DCP was perceived as acceptable and beneficial by patients and staff. Both groups were aware of the potential participant burden if surveys were too long. Introducing a DCP could be a valuable adjunct to current management care models, providing a standardised source of education with the potential for individualised tracking and monitoring. The design and development of a DCP will need to consider reported facilitators and address perceived barriers for engagement. PATIENT OR PUBLIC CONTRIBUTION This project sought insights from patients and staff about a digital care pathway. This forms the first step of patient and consumer consultation before implementing a digital care pathway. All consumers were offered the opportunity to review their responses and our interpretation.
Collapse
Affiliation(s)
- Emily C. Bell
- Discipline of PhysiotherapyLa Trobe UniversityBundooraAustralia
- Department of Allied HealthNorthern HealthEppingAustralia
| | - Hazel Heng
- Discipline of PhysiotherapyLa Trobe UniversityBundooraAustralia
- Department of Allied HealthNorthern HealthEppingAustralia
| | - Nicole Alousis
- Department of Allied HealthNorthern HealthEppingAustralia
| | - Matthew G. King
- Discipline of PhysiotherapyLa Trobe UniversityBundooraAustralia
| | - Andrew Hahne
- Discipline of PhysiotherapyLa Trobe UniversityBundooraAustralia
| | - Thomas Collins
- Department of Allied HealthNorthern HealthEppingAustralia
| | - Katharine See
- Digital Health Division, Clinical Leadership, Effectiveness & OutcomesNorthern HealthEppingAustralia
| | - Tracey Webster
- Digital Health Division, Clinical Leadership, Effectiveness & OutcomesNorthern HealthEppingAustralia
| | - Elisha O'Dowd
- Digital Health Division, Clinical Leadership, Effectiveness & OutcomesNorthern HealthEppingAustralia
| | - Paul Jackson
- Department of Allied HealthNorthern HealthEppingAustralia
| | - Adam I. Semciw
- Discipline of PhysiotherapyLa Trobe UniversityBundooraAustralia
- Department of Allied HealthNorthern HealthEppingAustralia
| |
Collapse
|
2
|
Pannu CD, Hess M, Baxter D. Osteoid osteoma presenting with scoliosis: successful resection with endoscopic excision. BMJ Case Rep 2024; 17:e258346. [PMID: 38453226 PMCID: PMC10921494 DOI: 10.1136/bcr-2023-258346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
A young male in his mid-teen years presented with severe back pain for 3 months and was subsequently diagnosed with osteoid osteoma in the left superior articular process of the L4 vertebra. Initial treatment with non-steroidal anti-inflammatory drugs provided temporary relief. Due to concerns about scoliosis progression along with unrelieved pain, a multidisciplinary team recommended endoscopic excision of the osteoid osteoma. The procedure resulted in complete pain relief and an improvement in the scoliosis curve from 22° of Cobb's angle to 12 degrees at the 8-month follow-up.
Collapse
Affiliation(s)
- Chaitanya Dev Pannu
- Specialist Surgery, Royal National Orthopaedic Hospital NHS Trust, London, UK
| | | | - David Baxter
- Neurosurgery, Royal National Orthopaedic Hospital NHS Trust, London, UK
| |
Collapse
|
3
|
Li Z, Gao X, Ding W, Li R, Yang S. Asymmetric distribution of Modic changes in patients with lumbar disc herniation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1741-1750. [PMID: 36977942 DOI: 10.1007/s00586-023-07664-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/13/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE This study aims to report a new distribution pattern of Modic changes (MCs) in patients with lumbar disc herniation (LDH) and investigate the prevalence, correlative factors and clinical outcomes of asymmetric Modic changes (AMCs). METHODS The study population consisted of 289 Chinese Han patients who were diagnosed with LDH and single-segment MCs from January 2017 to December 2019. Demographic, clinical and imagological information was collected. Lumbar MRI was performed to assess MCs and intervertebral discs. The visual analogue score (VAS) and Oswestry disability index (ODI) were evaluated in patients undergoing surgery preoperatively and at the final follow-up. Correlative factors contributing to AMCs were analysed by multivariate logistic regression. RESULTS The study population included 197 patients with AMCs and 92 patients with symmetric Modic changes (SMCs). The incidence of leg pain (P < 0.001) and surgical treatment (P = 0.027) in the AMC group was higher than that in the SMC group. The VAS of low back pain was lower (P = 0.048), and the VAS of leg pain was higher (P = 0.036) in the AMC group than in the SMC group preoperatively. Multivariate logistic regression analysis revealed that leg pain (OR = 2.169, 95% CI = 1.218 ~ 3.864) and asymmetric LDH (OR = 7.342, 95% CI = 4.170 ~ 12.926) were independently associated with AMCs. The receiver operating characteristic curve showed an AUC of 0.765 (P < 0.001). CONCLUSION AMCs were a more common phenomenon than SMCs in this study. The asymmetric and symmetric distribution of MCs was closely related to LDH position. AMCs were related to leg pain and higher pain levels. Surgery can achieve satisfactory clinical improvement for asymmetric and symmetric MCs.
Collapse
Affiliation(s)
- Zhaohui Li
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Xianda Gao
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Wenyuan Ding
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China.
| | - Ruoyu Li
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Sidong Yang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, China.
| |
Collapse
|
4
|
Ozden M, Silav ZK. Correlations of Disc Tissue Pathological Changes With Pfirrmann Grade in Patients With Disc Herniation Treated With Microdiscectomy. Cureus 2023; 15:e37913. [PMID: 37220462 PMCID: PMC10200016 DOI: 10.7759/cureus.37913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND To reveal whether pathological disc changes (vascularization, inflammation, disc aging and senescence as assessed with immunohistopathological CD34, CD68, brachyury and P53 staining densities respectively) are associated with the extent of disease (Pfirrmann grade) and lumbar radicular pain in patients with lumbar disc herniation. We selectively included a homogenous group of 32 patients (16 males and 16 females) with single-level sequestered discs who had disease stages between Pfirrmann grades I to IV and excluded patients with the complete collapse of the disc space to determine histopathological correlations of the disease more precisely. MATERIALS AND METHODS Pathological assessments were performed on surgically excised disc specimens stored in a -80°C refrigerator. Preoperative and postoperative pain intensities were determined with visual analog scales (VASs). Pfirrmann disc degeneration grades were determined on routine T2-weighted magnetic resonance imaging (MRI). RESULTS Stainings were especially observed with CD34 and CD68, which positively correlated with each other and Pfirrmann grading but not with VAS scores or patients' age. Weak nuclear staining with brachyury was observed in 50% of patients and did not correlate with disease features. Focal weak staining with P53 was only seen in the disc specimen of two patients. CONCLUSIONS In the pathogenesis of disc disease, inflammation may trigger angiogenesis. The subsequent aberrant increase of oxygen perfusion in the disc cartilage may cause further damage, as the disc tissue is adapted to hypoxia. This vicious cycle of inflammation and angiogenesis may be a future innovative therapeutic target for chronic degenerative disc disease.
Collapse
Affiliation(s)
- Mahmut Ozden
- Neurosurgery, Memorial Bahcelievler Hospital, Istanbul, TUR
| | - Zuhal K Silav
- Pathology, Sadi Konuk Education and Research Hospital, Bakirkoy, TUR
| |
Collapse
|
5
|
Pan X, Qiao J, Liu Z, Sun X, Zhu Z. Spontaneous correction of scoliosis after curettage of spinal osteoid osteoma: How and when? J Orthop Surg Res 2022; 17:534. [PMID: 36503626 PMCID: PMC9743737 DOI: 10.1186/s13018-022-03423-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Scoliosis behavior after curettage of spinal osteoid osteoma has been not clarified as most studies regarding scoliosis secondary to osteoid osteoma (OO) were case reports. The aims of this study were to investigate (1) clinical and radiographic features of scoliosis secondary to OO; (2) scoliosis behavior after Curettage of OO. METHODS A retrospective study was performed at patients who were diagnosed as OO clinically or pathologically from July 1998 to December 2019 in a single institution. Age, gender, location of pain, location of lesion and curve pattern of scoliosis were collected preoperatively. Intraoperative blood loss, operation time and surgical complications were documented. VAS scores and curve magnitude were collected pre- and postoperatively and at last follow-up. RESULTS The mean operation time was 124 ± 32 min and the average intraoperative blood loss was 274 ± 134 ml. The mean preoperative VAS score was 6.2 ± 2.7, and the mean postoperative VAS score was 2.1 ± 1.8. Thoracic scoliosis was improved from 22.7 ± 10.6° to 6.2 ± 4.3° after operation, and to 4.1 ± 4.3° at last follow-up. Lumbar scoliosis was improved from 18.1 ± 7.4° to 6.7 ± 5.2° after operation, and to 5.3 ± 3.9° at last follow-up. Trunk shift was improved from 34.7 ± 12.4 to 10.5 ± 7.2 mm after operation, and to 8.4 ± 5.6 mm at last follow-up. There was no significant differences as to sagittal radiographic parameters (P > 0.05). CONCLUSION Patients with spinal OO had a significantly high incidence of scoliosis. Patients could get rapid relief of pain and scoliosis with low occurrence. Night pain, pain at the concave side of curve, normal sagittal alignment could help differentiate it from scoliosis associated with lumbar disc herniation.
Collapse
Affiliation(s)
- Xiyu Pan
- grid.428392.60000 0004 1800 1685Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008 China
| | - Jun Qiao
- grid.428392.60000 0004 1800 1685Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008 China
| | - Zhen Liu
- grid.428392.60000 0004 1800 1685Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008 China
| | - Xu Sun
- grid.428392.60000 0004 1800 1685Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008 China
| | - Zezhang Zhu
- grid.428392.60000 0004 1800 1685Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008 China
| |
Collapse
|
6
|
Tang Y, Liu Z, Liu H, Zhang J, Zhu X, Qian Z, Yang H, Mao H, Zhang K, Chen H, Chen K. A comparative study of single and double incision for L4/5 and L5/S1 double-level percutaneous interlaminar lumbar discectomy. Front Surg 2022; 9:955987. [PMID: 36111227 PMCID: PMC9468222 DOI: 10.3389/fsurg.2022.955987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aims to investigate the clinical outcome of single and double incision for double-level percutaneous interlaminar lumbar discectomyMethodsA retrospective analysis was performed involving patients with L4/5 and L5/S1 double-level lumbar disc herniation who received percutaneous interlaminar lumbar discectomy (PEID) in our hospital from January 2017 to December 2020. These enrolled patients were divided into single- and double-incision groups, with 25 patients in each group. We compared the incision length, operation time, fluoroscopy times, and length of hospital stay between the two groups. Meanwhile, the postoperative visual analogue scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopedic Association score (JOA), and modified MacNab standard were used to evaluate the outcomes of the patients within the two groups.ResultsIt showed that the single-incision group performed better than double-incision group in incision length, operation time, and fluoroscopy times (P < 0.001). The VAS score, JOA score, and ODI index in the two groups were significantly decreased at the time points of postsurgery, 1 month after surgery, and the last follow-up (P < 0.01), but there was no statistical significance between the two groups involving above parameters (P > 0.05). At the last follow-up, the excellent and good rates of MacNab efficacy in the two groups were 92% and 88%, respectively, but no significant difference was observed between the two groups (P > 0.05).ConclusionBoth the single- and double-incision approaches are effective and safe for managing L4/5 and L5/S1 double-level LDH. Single-incision PEID for treating L4/5 and L5/S1 double-segment lumbar disc herniation has advantages of less trauma, fewer intraoperative fluoroscopy times, and shorter operation time, as compared to double-incision PEID. However, the operation of double-segment LDH through a single laminar incision is difficult, the learning curve is steep, and professional skill is highly required. Importantly, the surgical indications should be strictly grasped.
Collapse
Affiliation(s)
- Yingchuang Tang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zixiang Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hao Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Junxin Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoyu Zhu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhonglai Qian
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huilin Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haiqing Mao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Kai Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Correspondence: Kangwu Chen Hao Chen Kai Zhang
| | - Hao Chen
- Department of Orthopedic Surgery, Affiliated Hospital of Yangzhou University, Yangzhou, China
- Correspondence: Kangwu Chen Hao Chen Kai Zhang
| | - Kangwu Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Correspondence: Kangwu Chen Hao Chen Kai Zhang
| |
Collapse
|
7
|
Du Y, Li J, Tang X, Liu Y, Bian G, Shi J, Zhang Y, Zhao B, Zhao H, Sui K, Xi Y. The Thermosensitive Injectable Celecoxib-Loaded Chitosan Hydrogel for Repairing Postoperative Intervertebral Disc Defect. Front Bioeng Biotechnol 2022; 10:876157. [PMID: 35837544 PMCID: PMC9274121 DOI: 10.3389/fbioe.2022.876157] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Percutaneous endoscopic lumbar discectomy has been widely used in clinical practice for lumbar spine diseases. But the postoperative disc re-herniation and inflammation are the main reason for pain recurrence after surgery. The postoperative local defect of the intervertebral disc will lead to the instability of the spine, further aggravating the process of intervertebral disc degeneration. In this work, we successfully synthesized the thermosensitive injectable celecoxib-loaded chitosan hydrogel and investigated its material properties, repair effect, biocompatibility, and histocompatibility in in vitro and in vivo study. In vitro and in vivo, the hydrogel has low toxicity, biodegradability, and good biocompatibility. In an animal experiment, this composite hydrogel can effectively fill local tissue defects to maintain the stability of the spine and delay the process of intervertebral disc degeneration after surgery. These results indicated that this composite hydrogel will be a promising way to treat postoperative intervertebral disc disease in future clinical applications.
Collapse
Affiliation(s)
- Yukun Du
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianyi Li
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaojie Tang
- Department of Spinal Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Yingying Liu
- State Key Laboratory of Bio-Fibers and Eco-Textiles, College of Materials Science and Engineering, Shandong Collaborative Innovation Center of Marine Biobased Fibers and Ecological Textiles, Qingdao University, Qingdao, China
| | - Guoshuai Bian
- State Key Laboratory of Bio-Fibers and Eco-Textiles, College of Materials Science and Engineering, Shandong Collaborative Innovation Center of Marine Biobased Fibers and Ecological Textiles, Qingdao University, Qingdao, China
| | - Jianzhuang Shi
- State Key Laboratory of Bio-Fibers and Eco-Textiles, College of Materials Science and Engineering, Shandong Collaborative Innovation Center of Marine Biobased Fibers and Ecological Textiles, Qingdao University, Qingdao, China
| | - Yixin Zhang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- Health Care Ward III, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Baomeng Zhao
- Department of Surgery teaching and research, Binzhou Medical University, Yantai, China
| | - Hongri Zhao
- Department of Spinal Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Kunyan Sui
- State Key Laboratory of Bio-Fibers and Eco-Textiles, College of Materials Science and Engineering, Shandong Collaborative Innovation Center of Marine Biobased Fibers and Ecological Textiles, Qingdao University, Qingdao, China
- *Correspondence: Kunyan Sui, ; Yongming Xi,
| | - Yongming Xi
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Kunyan Sui, ; Yongming Xi,
| |
Collapse
|